Publications by authors named "Andrzej Surdacki"

88 Publications

Low-grade chronic inflammation and immune alterations in childhood and adolescent cancer survivors: A contribution to accelerated aging?

Cancer Med 2021 Mar 19;10(5):1772-1782. Epub 2021 Feb 19.

Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, Krakow, Poland.

Background: The long-term consequences of chemotherapy and radiotherapy result in a high prevalence and early onset of age-related chronic diseases in survivors. We aimed to examine whether childhood and adolescent cancer survivors (CS) demonstrate biomarkers of accelerated aging.

Methods: We evaluated 50 young adult CS at 11 [8-15] years after cancer diagnosis, and 30 healthy, age and sex-matched controls, who were unexposed to cancer therapy. Using a machine-learning approach, we assessed factors discriminating CS from controls and compared selected biomarkers and lymphocyte subpopulations with data from the Framingham Heart Study (FHS) cohort and the Genotype Tissue Expression (GTEx) project.

Results: Survivors compared with controls had higher levels of C-reactive protein and fibrinogen. The surface expression of CD38 on T cells was increased, and there was an increase in the percentage of memory T cells in survivors, compared with the unexposed group. The relationships between above cell subpopulations and age were consistent in CS, FHS, and GTEx cohorts, but not in controls.

Conclusions: Young pediatric cancer survivors differ from age-related controls in terms of activation of the adaptive immune system and chronic, low-grade inflammation. These changes resemble aging phenotype observed in older population. Further research in biomarkers of aging in young, adult childhood cancer survivors is warranted, as it may facilitate screening and prevention of comorbidities in this population.
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http://dx.doi.org/10.1002/cam4.3788DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7940211PMC
March 2021

Five-year report from the Polish national registry on percutaneous coronary interventions with a focus on coronary artery perforations within chronic total occlusions.

Postepy Kardiol Interwencyjnej 2020 Dec 29;16(4):399-409. Epub 2020 Dec 29.

Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland.

Introduction: Patients treated within chronic total occlusions (CTO) using percutaneous coronary intervention (PCI) are at increased risk of periprocedural complications.

Aim: To assess the frequency of periprocedural complications with particular emphasis on coronary artery perforations (CAPs) among patients treated with PCIs stratified according to CTOs and their predictors.

Material And Methods: Based on a nationwide registry (ORPKI), we analysed 535,853 patients treated with PCI between 2014 and 2018. The study included 12,572 (2.34%) patients treated with CTO PCI. We compared CTO PCI to a non-CTO PCI group before and after propensity score matching (PSM). Multifactorial mixed regression models were used to assess predictors of periprocedural complications and CAPs which occurred within the catheterization laboratory.

Results: Frequencies of all periprocedural complications (2.75% vs. 1.93%, < 0.001) and CAP (0.72% vs. 0.16%, < 0.001) were significantly higher in the CTO PCI group. Multifactorial regression analysis performed in the all-comers group of patients treated with PCI showed that PCI within CTO was related to a higher CAP rate (odds ratio (OR) = 2.18; 95% confidence interval (CI): 1.68-2.82, < 0.001). After PSM, we extracted 5,652 patients treated within CTO and 5,652 patients with non-CTO PCI. CTO PCI was also related to a higher frequency of CAPs (OR = 1.89; 95% CI: 1.11-3.31, = 0.01).

Conclusions: The frequency of periprocedural complications and CAPs remained stable during the assessed period of time. CTO PCI was confirmed to be among the predictors of increased CAP rate in the overall group of patients treated within CTO.
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http://dx.doi.org/10.5114/aic.2020.101764DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7863825PMC
December 2020

Spontaneous coronary dissection and asymptomatic splenic artery aneurysms in a young woman.

Postepy Kardiol Interwencyjnej 2020 Sep 2;16(3):340-342. Epub 2020 Oct 2.

nd Department of Cardiology, Jagiellonian University Medical College, Krakow, Poland.

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http://dx.doi.org/10.5114/aic.2020.99272DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7863796PMC
September 2020

Assessment of mitral regurgitation and mitral complex geometry in patients after transcatheter aortic valve implantation.

Postepy Kardiol Interwencyjnej 2020 Sep 2;16(3):300-305. Epub 2020 Oct 2.

Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland.

Introduction: Mitral regurgitation (MR) of varying degrees and mechanisms is a common finding in patients with aortic stenosis with different improvement after transcatheter aortic valve implantation (TAVI).

Aim: To evaluate the impact of TAVI on mitral complex geometry and the degree of MR.

Material And Methods: A total of 31 patients (29.0% males) with severe aortic stenosis and moderate or severe MR at the baseline who underwent TAVI were included in this study. Clinical and echocardiographic characteristics were determined at baseline and at 6 and 12 months.

Results: After TAVI, decrease of MR vena contracta width ( = 0.00002, = 0.00004), aorto-mural mitral annulus diameter ( = 0.00008, = 0.02), increase of mitral annular plane systolic excursion ( = 0.0004, = 0.0003), left ventricular stroke volume ( = 0.0003, = 0.0004), ejection fraction ( = 0.0004, = 0.01) and decrease of major dimension of left ventricle in three chamber view ( = 0.05, = 0.002) were observed in patients at both time points. Additionally, we observed a decrease of distance between the head of the papillary muscles ( = 0.003) at 6 months and a decrease of left atrium volume index ( = 0.01) and systolic pulmonary artery pressure ( = 0.01) at 12 months.

Conclusions: Patients with moderate or severe MR undergoing TAVI achieved significant improvement of mitral valve complex function resulting in the reduction of MR degree.
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http://dx.doi.org/10.5114/aic.2020.99265DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7863815PMC
September 2020

Aspiration Thrombectomy in Patients with Acute Myocardial Infarction-5-Year Analysis Based on a Large National Registry (ORPKI).

J Clin Med 2020 Nov 9;9(11). Epub 2020 Nov 9.

2nd Department of Cardiology and Cardiovascular Interventions, University Hospital, 30-688 Kraków, Poland.

Blood flow restoration after primary percutaneous coronary intervention (pPCI) in patients with acute myocardial infarction (AMI) may not always be achieved and could be complicated by the no-reflow phenomenon (NRP). The aim of the current study was to assess the frequency of thrombus aspirations (TAs) and NRPs in patients with AMI and treated with pPCI based on the data collected during a 5-year period in the national ORPKI registry, as well as the frequency of periprocedural strokes and predictors of TA and NRP. This retrospective analysis was performed on prospectively collected data gathered in the Polish National Registry of Percutaneous Coronary Interventions (ORPKI), which covered the period between January 2014 and December 2018, and included 200,991 patients treated due to AMI out of 535,857 patients treated using PCI. Among them, 16,777 patients underwent TA. TA was mainly used in the STEMI subgroup of 14,207 patients (84.8%). The frequency of NRP among AMI patients in the thrombectomy group was 2.75% and in the non-thrombectomy group 0.82%. Predictors of TA and NRP were also assessed using multivariate analysis. The percentage of patients treated with pPCI and with PCI alone increased significantly in all of the three selected groups of patients from 88.7% to 94.3% in the AMI group ( < 0.001), from 82.3% to 90.3% in the STEMI subgroup ( < 0.001), and from 96.3% to 98.2% in the NSTEMI subgroup ( < 0.001) during the analysed period. NRP occurred more often in the thrombectomy group for the NSTEMI (0.58% vs. 3.07%, < 0.05) and STEMI (1.06% vs. 2.69%, < 0.05) subgroups. Periprocedural stroke occurred more often in the thrombectomy group in comparison to the non-thrombectomy group with AMI (0.03% vs. 0.01%, < 0.05) and the NSTEMI (0.16% vs. 0.02%, < 0.05). In conclusion, the frequency of TA has been experiencing a steady decline in recent years, regardless of AMI type, among patients treated with pPCI.
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http://dx.doi.org/10.3390/jcm9113610DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7698028PMC
November 2020

Biotransformation of organic nitrates by glutathione S-transferases and other enzymes: An appraisal of the pioneering work by William B. Jakoby.

Anal Biochem 2020 Oct 17:113993. Epub 2020 Oct 17.

Second Department of Cardiology, Jagiellonian University Medical Colleague and University Hospital, Cracow, Poland.

Organic nitrates (R-ONO; R, organic residue) such as nitroglycerin are used as drugs in part for more than a century. Their pharmacological use is associated with clinically relevant tolerance which is reportedly known since 1888. The underlying mechanisms of both, the mechanisms of action and the main pharmacological effect, which is vasodilatation and reduction of blood pressure, and the development of tolerance, which means increasing need of drug amount in sustained long-term therapy, are still incompletely understood. William B. Jakoby and associates were the first to report the biotransformation of organic nitrates, notably including nitroglycerin (i.e., glycerol trinitrate; GTN), by glutathione S-transferase (GST)-catalyzed conjugation of glutathione (GSH) to the nitrogen atom of one of the three nitrate groups of GTN to generate glutathione sulfenyl nitrite (glutathione thionitrate, S-nitroglutathione; GSNO). Jakoby's group was also the first to suggest that GSNO reacts with a second GSH molecule to produce inorganic nitrite (ONO) and glutathione disulfide (GSSG) without the catalytic involvement of GST. This mechanism has been adopted by others to the biotransformation of GTN by mitochondrial aldehyde dehydrogenase (mtALDH-(CysSH)) which does not require GSH as a substrate. The main difference between these reactions is that mtALDH forms an internal thionitrate (mtALDH-(CysSH)-CysSNO) which releases inorganic nitrite upon intra-molecular reaction to form mtALDH disulfide (mtALDH-(CysS)). Subsequently, ONO and GSNO are reduced by several proteins and enzymes to nitric oxide (NO) which is a very potent activator of soluble guanylyl cyclase to finally relax the smooth muscles thus dilating the vasculature. GSNO is considered to rearrange to GSONO which undergoes further reactions including GSNO and GSSG formation. The present article is an appraisal of the pioneering work of William B. Jakoby in the area of the biotransformation of organic nitrates by GST. The two above mentioned enzymatic reactions are discussed in the context of tolerance development to organic nitrates, still a clinically relevant pharmacological concern.
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http://dx.doi.org/10.1016/j.ab.2020.113993DOI Listing
October 2020

Urgent Pericardiocentesis Is More Frequently Needed After Left Circumflex Coronary Artery Perforation.

J Clin Med 2020 Sep 21;9(9). Epub 2020 Sep 21.

Second Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, 30-688 Cracow, Poland.

Coronary artery perforation (CAP) is a rare but potentially life-threatening complication of percutaneous coronary interventions (PCIs) due to the risk of cardiac tamponade. Strikingly, in contrast to numerous analyses of CAP predictors, only few studies were focused on the predictors of tamponade after PCI, once iatrogenic CAP has occurred. Our aim was to search for clinical and periprocedural characteristics, including the coronary artery involved, associated with the development of acute cardiac tamponade among patients experiencing CAP. From the medical records of nine centers of invasive cardiology in southern Poland, we retrospectively selected 81 patients (80% with acute myocardial infarction) who had iatrogenic CAP with a visible extravasation jet during angiography (corresponding to type III CAP by the Ellis classification, CAP) over a 15-year period (2005-2019). Clinical, angiographic and periprocedural characteristics were compared between the patients who developed acute cardiac tamponade requiring urgent pericardiocentesis in the cathlab (n = 21) and those with CAP and without tamponade (n = 60). CAP were situated in the left anterior descending artery (LAD) or its diagonal branches (51%, n = 41), right coronary artery (RCA) (24%, n = 19), left circumflex coronary artery (LCx) (16%, n = 13), its obtuse marginal branches (7%, n = 6) and left main coronary artery (2%, n = 2). Acute cardiac tamponade occurred in 24% (10 of 41), 21% (4 of 19) and 37% (7 of 19) patients who experienced CAP in the territory of LAD, RCA and LCx, respectively. There were no significant differences in the need for urgent pericardiocentesis (37%) in patients with CAP in LCx territory (i.e., the LCx or its obtuse marginal branches) compared to CAP in the remaining coronary arteries (23%) ( = 0.24). However, when CAP in the LCx were separated from CAP in obtuse marginal branches, urgent pericardiocentesis was more frequently performed in patients with CAP in the LCx (54%, 7 of 13) compared to subjects with CAP in an artery other than the LCx (21%, 14 of 68) ( = 0.03). The direction of this tendency remained consistent regardless of CAP management: prolonged balloon inflation only (n = 26, 67% vs. 13%, = 0.08) or balloon inflation with subsequent stent implantation (n = 55, 50% vs. 24%, = 0.13). Besides LCx involvement, no significant differences in other characteristics were observed between patients according to the need of urgent pericardiocentesis. CAP in the LCx appears to lead to a higher risk of acute cardiac tamponade compared to perforations involving other coronary arteries. This association may possibly be linked to distinct features of LCx anatomy and/or well-recognized delays in diagnosis and management of LCx-related acute coronary syndromes.
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http://dx.doi.org/10.3390/jcm9093043DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7565780PMC
September 2020

Long-Term Prognostic Significance of High-Sensitive Troponin I Increase during Hospital Stay in Patients with Acute Myocardial Infarction and Non-Obstructive Coronary Arteries.

Medicina (Kaunas) 2020 Aug 27;56(9). Epub 2020 Aug 27.

Department of Cardiology, Jagiellonian University Medical College, 40-055 Kraków, Poland.

A topic already widely investigated is the negative prognostic value regarding the extent of high sensitive troponin I (hs-TnI) increases among patients with myocardial infarction (MI) and obstructive coronary atherosclerosis compared to a group of patients with MI and non-obstructive coronary atherosclerosis (MINOCA). Thus, the aim of this study was to evaluate the prognostic value concerning the extent of hs-TnI increase on clinical outcomes among patients with a MINOCA working diagnosis. We selected 337 consecutive patients admitted to hospital with a working diagnosis of MINOCA. The patients were divided in three groups according to the extent of hs-TnI increase during hospitalization (increase ≤5-times above the limit of the upper norm, >5 and ≤20-times, and >20-times). The study endpoints included all-cause mortality and major adverse cardiac and cerebrovascular events (MACCE; cerebral stroke and transient ischemic attacks, MI, coronary artery revascularization, either percutaneous coronary intervention or coronary artery bypass grafting and all-cause mortality). During the mean follow-up period of 516.1 ± 239.8 days, using Kaplan-Meier survival curve analysis, significantly higher mortality rates were demonstrated among patients from the group with the greatest hs-TnI increase compared to the remaining groups ( = 0.01) and borderline values for MACCE ( = 0.053). Multivariable cox regression analysis did not confirm hs-TnI among factors related to increased MACCE or all-cause mortality rates. While a relationship between clinical outcomes and the extent of the hs-TnI increase among patients with a MINOCA working diagnosis remains, it does not seem to be not as strong as it is in patients with obstructive coronary atherosclerosis.
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http://dx.doi.org/10.3390/medicina56090432DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7557849PMC
August 2020

Depressed Cardiac Mechanical Energetic Efficiency: A Contributor to Cardiovascular Risk in Common Metabolic Diseases-From Mechanisms to Clinical Applications.

J Clin Med 2020 Aug 19;9(9). Epub 2020 Aug 19.

Department of Cardiology and Cardiovascular Interventions, University Hospital, 2 Jakubowskiego Street, 30-688 Cracow, Poland.

Cardiac mechanical energetic efficiency is the ratio of external work (EW) to the total energy consumption. EW performed by the left ventricle (LV) during a single beat is represented by LV stroke work and may be calculated from the pressure-volume loop area (PVLA), while energy consumption corresponds to myocardial oxygen consumption (MVO) expressed on a per-beat basis. Classical early human studies estimated total mechanical LV efficiency at 20-30%, whereas the remaining energy is dissipated as heat. Total mechanical efficiency is a joint effect of the efficiency of energy transfer at three sequential stages. The first step, from MVO to adenosine triphosphate (ATP), reflects the yield of oxidative phosphorylation (i.e., phosphate-to-oxygen ratio). The second step, from ATP split to pressure-volume area, represents the proportion of the energy liberated during ATP hydrolysis which is converted to total mechanical energy. Total mechanical energy generated per beat-represented by pressure-volume area-consists of EW (corresponding to PVLA) and potential energy, which is needed to develop tension during isovolumic contraction. The efficiency of the third step of energy transfer, i.e., from pressure-volume area to EW, decreases with depressed LV contractility, increased afterload, more concentric LV geometry with diastolic dysfunction and lower LV preload reserve. As practical assessment of LV efficiency poses methodological problems, De Simone et al. proposed a simple surrogate measure of myocardial efficiency, i.e., mechano-energetic efficiency index (MEEi) calculated from LV stroke volume, heart rate and LV mass. In two independent cohorts, including a large group of hypertensive subjects and a population-based cohort (both free of prevalent cardiovascular disease and with preserved ejection fraction), low MEEi independently predicted composite adverse cardiovascular events and incident heart failure. It was hypothesized that the prognostic ability of low MEEi can result from its association with both metabolic and hemodynamic alterations, i.e., metabolic syndrome components, the degree of insulin resistance, concentric LV geometry, LV diastolic and discrete systolic dysfunction. On the one part, an increased reliance of cardiomyocytes on the oxidation of free fatty acids, typical for insulin-resistant states, is associated with both a lower yield of ATP per oxygen molecule and lesser availability of ATP for contraction, which might decrease energetic efficiency of the first and second step of energy transfer from MVO to EW. On the other part, concentric LV remodeling and LV dysfunction despite preserved ejection fraction can impair the efficiency of the third energy transfer step. In conclusion, the association of low MEEi with adverse cardiovascular outcome might be related to a multi-step impairment of energy transfer from MVO to EW in various clinical settings, including metabolic syndrome, diabetes, hypertension and heart failure. Irrespective of theoretical considerations, MEEi appears an attractive simple tool which couldt improve risk stratification in hypertensive and diabetic patients for primary prevention purposes. Further clinical studies are warranted to estimate the predictive ability of MEEi and its post-treatment changes, especially in patients on novel antidiabetic drugs and subjects with common metabolic diseases and concomitant chronic coronary syndromes, in whom the potential relevance of MEE can be potentiated by myocardial ischemia.
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http://dx.doi.org/10.3390/jcm9092681DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7565585PMC
August 2020

Comparison of the Characteristics of Coronary Interventions Performed During Day and Night Shifts in Patients with Acute Myocardial Infarction.

Int J Environ Res Public Health 2020 07 26;17(15). Epub 2020 Jul 26.

Second Department of Cardiology, Jagiellonian University Medical College, 2 Jakubowskiego Street, 30-688 Cracow, Poland.

Therapeutic percutaneous coronary intervention (PCI) is the treatment of choice in acute myocardial infarction (AMI). If optimally performed, PCI reduces myocardial injury and improves the likelihood of a positive clinical outcome. Therefore, the equal quality of PCI throughout both day and night shifts is of paramount importance. Our aim was to compare urgent diagnostic and therapeutic coronary interventions performed during day and night shifts. We retrospectively analyzed the medical records of 144 patients who underwent coronary angiography for AMI over six months in a tertiary referral center working in 24/7 mode. The patients' characteristics, procedural data and the operator's experience in interventional cardiology were compared according to the time of intervention during a day shift (8 a.m. until 8 p.m., group A, = 106) and night shift (from 8 p.m. until 8 a.m. next day, group B, = 36). The baseline characteristics of the subjects of groups A and B were similar, except for a higher proportion of AMI without persistent ST-segment elevation (NSTEMI) in patients who underwent coronary angiography during regular working hours compared to off-hours (58% vs. 34%, < 0.05). The average time of diagnostic coronary angiography was longer by about 5 min during the day shift (28.5 ± 12.2 vs. 23.8 ± 8.9 min, < 0.05), while other procedural data, including the arterial access route, the number of catheters needed and the contrast-medium volume, were similar. The use of additional diagnostic tools for coronary lesion assessment (intracoronary ultrasound or fractional flow reserve measurement) was almost twice as frequent during regular working hours (15% vs. 8%). Urgent therapeutic PCI on the culprit artery was performed in 79% and 89% of group A and B patients, respectively. The groups did not differ in procedural characteristics regarding the total interventional session, including both diagnostic angiography and therapeutic PCI, such as total procedure duration, fluoroscopy time, radiation dose, stenting technique and total stent length. Coronary thrombectomy or rotational atherectomy were more frequently used in group A (27% vs. 15%, = 0.16). The percentage of doctors with the least experience in interventional cardiology was, albeit insignificantly, lower during day shifts (31% vs. 42%). In conclusion, the majority of clinical and periprocedural characteristics appeared to be independent of intervention time, except for a longer duration of diagnostic coronary angiography during daytime. This finding could probably result from a higher proportion of NSTEMI patients frequently requiring additional angiographic projections and special techniques to properly identify the infarct-related artery during the day shift. Whether a tendency of less frequent use of additional tools at off-hours may also be due to a lower percentage of NSTEMI interventions at night, or whether this can be linked to lower availability of experienced operators, remains to be validated in a large study. The latter possibility, if confirmed, might encourage public health authorities and healthcare organizers to improve off-hours cathlab staffing with experienced interventionalists. Finally, additional obligatory training in special diagnostic and therapeutic invasive techniques might be advisable for the least experienced operators scheduled to work night shifts.
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http://dx.doi.org/10.3390/ijerph17155378DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7432738PMC
July 2020

Endothelial Dysfunction: A Contributor to Adverse Cardiovascular Remodeling and Heart Failure Development in Type 2 Diabetes beyond Accelerated Atherogenesis.

J Clin Med 2020 Jul 3;9(7). Epub 2020 Jul 3.

Second Department of Cardiology, Jagiellonian University Medical College, Jakubowskiego Street, 30-688 Cracow, Poland.

Endothelial dysfunction, associated with depressed nitric oxide (NO) bioavailability, is awell-recognized contributor to both accelerated atherogenesis and microvascular complications intype 2 diabetes (DM). However, growing evidence points to the comorbidities-driven endothelialdysfunction within coronary microvessels as a key player responsible for left ventricular (LV)diastolic dysfunction, restrictive LV remodeling and heart failure with preserved ejection fraction(HFpEF), the most common form of heart failure in DM. In this review we have described: (1)multiple cellular pathways which may link depressed NO bioavailability to LV diastolicdysfunction and hypertrophy; (2) hemodynamic consequences and prognostic effects of restrictiveLV remodeling and combined diastolic and mild systolic LV dysfunction on cardiovascularoutcomes in DM and HFpEF, with a focus on the clinical relevance of endothelial dysfunction; (3)novel therapeutic strategies to improve endothelial function in DM. In summary, beyondassociations with accelerated atherogenesis and microvascular complications, endothelialdysfunction supplements the multiple interwoven pathways affecting cardiomyocytes, endothelialcells and the extracellular matrix with consequent LV dysfunction in DM patients. The associationamongst impaired endothelial function, reduced coronary flow reserve, combined LV diastolic anddiscrete systolic dysfunction, and low LV stroke volume and preload reserve-all of which areadverse outcome predictors-is a dangerous constellation of inter-related abnormalities, underlyingthe development of heart failure. Nevertheless, the relevance of endothelial effects of novel drugsin terms of their ability to attenuate cardiovascular remodeling and delay heart failure onset in DMpatients remains to be investigated.
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http://dx.doi.org/10.3390/jcm9072090DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7408687PMC
July 2020

Low Ejection Fraction Predisposes to Contrast-Induced Nephropathy after the Second Step of Staged Coronary Revascularization for Acute Myocardial Infarction: A Retrospective Observational Study.

J Clin Med 2020 Jun 10;9(6). Epub 2020 Jun 10.

Second Department of Cardiology, Jagiellonian University Medical College, 2 Jakubowskiego Street, 30-688 Cracow, Poland.

Patients who develop contrast-induced nephropathy (CIN) are at an increased short-term and long-term risk of adverse cardiovascular (CV) events. Our aim was to search for patient characteristics associated with changes in serum creatinine and CIN incidence after each step of two-stage coronary revascularization in patients with acute myocardial infarction (AMI) and multivessel coronary artery disease undergoing staged coronary angioplasty during hospitalization for AMI. We retrospectively analyzed medical records of 138 patients with acute myocardial infarction without hemodynamic instability, in whom two-stage coronary angioplasty was performed during the initial hospital stay. In-hospital serum creatinine levels were recorded before the 1st intervention (at admission), within 72 h after the 1st intervention (before the 2nd intervention), and within 72 h after the 2nd intervention. The incidence of CIN was 2% after the 1st intervention (i.e., primary angioplasty) and 8% after the 2nd intervention. Patients with significant left ventricular systolic dysfunction after the 1st intervention (ejection fraction (EF) ≤35%) exhibited higher relative rises in creatinine levels after the 2nd intervention (18 ± 29% vs. 2 ± 16% for EF ≤35% and >35%, respectively, 0.03), while respective creatinine changes after the 1st revascularization procedure were comparable (-1 ± 14% vs. 2 ± 13%, 0.4). CIN after the 2nd intervention was over five-fold more frequent in subjects with low EF (28% vs. 5%, 0.007). The association between low EF and CIN incidence or relative creatinine changes after the 2nd intervention was maintained upon adjustment for baseline renal function, major CV risk factors, and the use of renin-angiotensin axis antagonists prior to admission. In conclusion, low EF predisposes to CIN after second contrast exposure in patients undergoing two-stage coronary angioplasty during the initial hospitalization for AMI. Our findings suggest a need of extended preventive measures against CIN or even postponement of second coronary intervention in patients with significant left ventricular dysfunction scheduled for the second step of staged angioplasty.
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http://dx.doi.org/10.3390/jcm9061812DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7356857PMC
June 2020

An atypical manifestation of primary cardiac tumor in a young patient.

Postepy Kardiol Interwencyjnej 2020 Mar 25;16(1):110-111. Epub 2019 Dec 25.

2 Department of Cardiology, Jagiellonian University Medical College, Krakow, Poland.

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http://dx.doi.org/10.5114/aic.2019.91300DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7189134PMC
March 2020

Age and gender differences in clinical outcomes of patients with heavy-calcified coronary artery lesions treated percutaneously with rotational atherectomy.

Adv Clin Exp Med 2020 Feb;29(2):225-233

Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland.

Background: Rotational atherectomy (RA) used in elderly patients treated with percutaneous coronary interventions (PCI) could enable revascularization or the omission of cardiac surgery. Knowledge about factors affecting the prognosis may improve the results of treatment.

Objectives: We aimed to assess the relationship of gender and age with long-term clinical outcomes expressed as major adverse cardiac and cerebrovascular events (MACCEs).

Material And Methods: The study included 97 consecutive patients treated with PCI and RA at the mean age of 71. The study group contained 73.2% men and 26.8% women, 36.1% of patients older than 75 and 63.9% younger than 75. The mean time of follow-up was 695.3 ±560.9 days. The rate of MACCEs (deaths, myocardial infarctions (MIs), reinterventions, coronary artery by-pass surgeries, or cerebral strokes (CSs)/transient ischemic attacks (TIAs)) in the overall group of patients was calculated at 33.7%.

Results: The comparison of Kaplan-Meier survival curves did not depict significant differences in the frequency of MACCEs for age (p = 0.36) and gender (p = 0.07). We noticed that the death rate was higher in females than in males and in patients older than 75 compared to those younger, and was statistically significant for age (p = 0.04). The rate of periprocedural complications was significantly higher among women than among men (p = 0.005) and in patients older than 75 compared to the younger ones (p = 0.003).

Conclusions: Age and gender are not significantly associated with an increased rate of MACCEs during follow-up in elderly patients treated with PCI and RA.
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http://dx.doi.org/10.17219/acem/110314DOI Listing
February 2020

Novel antidiabetic drugs in diabetic kidney disease accompanying type 2 diabetes - a minireview.

Folia Med Cracov 2020 ;60(4):97-101

Second Department of Cardiology, Institute of Cardiology, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland.

Intensive hypoglycemic treatment is the strongest preventive strategy against the development of microvascular complications of type 2 diabetes (T2DM), including diabetic nephropathy. However, some antidiabetic drugs, i.e. sodium-glucose cotransporter-2 inhibitors (SGLT-2i) and glucagon-like peptide-1 receptor agonists (GLP1-RA) have an additional renoprotective effect beyond glucose control by itself. Similar, both SGLT-2i and GLP1-RA have been demonstrated to decrease the risk of adverse cardiovascular (CV) events in CV outcome trials. Nevertheless, there are relevant differences in CV and renal effects of SGLT-2i and GLP1-RA. First, SGLT2i reduced the incidence and progression of albuminuria and prevented loss of kidney function, while predominant renal benefits of GLP1-RA were driven by albuminuria outcomes. Second, the risk of heart failure (HF) hospitalizations decreased on SGLT2i but not on GLP1-RA, which gives priority to SGLT2i in T2DM and HF, especially with depressed EF. Third, either GLP1-RA (reducing predominantly atherosclerosis-dependent events) or SGLT-2i, should be used in T2DM and established atherosclerotic CV disease (ASCVD) or other indicators of high CV risk. In this review, we have briefly compared clinical practice guidelines of the American Diabetes Association (2020 and 2021 versions), Polish Diabetes Association (2020) and the European Society of Cardiology/European Association for the Study of Diabetes (2019), with a focus on the choice between SGLT-2i and GLP1-RA in patients with diabetic kidney disease.
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January 2020

Past strong experiences determine acute cardiovascular autonomic responses to acoustic stress.

Folia Med Cracov 2020 ;60(4):79-95

Department of Pathophysiology, Jagiellonian University Medical College, Kraków, Poland.

Background: Stress is a major risk factor for cardiovascular (CV) disease. We hypothesized that past strong experiences might modulate acute CV autonomic responses to an unexpected acoustic stimulus. A i m: The study's aim was to compare acute CV autonomic responses to acoustic stress between students with and without a past strong experience associated with the acoustic stimulus.

Materials And Methods: Twenty five healthy young volunteers - medical and non-medical students - were included in the study. CV hemodynamic parameters, heart rate (HR), and blood pressure (BP) variability were assessed for 10 min at rest and for 10 min after two different acoustic stimuli: a standard sound signal and a specific sound signal used during a practical anatomy exam (so-called "pins").

Results: Both sounds stimulated the autonomic nervous system. The "pins" signal caused a stronger increase in HR in medical students (69 ± 10 vs. 73 ± 13 bpm, p = 0.004) when compared to non-medical students (69 ± 6 vs. 70 ± 10, p = 0.695). Rises in diastolic BP, observed 15 seconds after sound stressors, were more pronounced after the "pins" sound than after the standard sound signal only in medical students (3.1% and 1.4% vs. 3% and 4.4%), which was also reflected by low-frequency diastolic BP variability (medical students: 6.2 ± 1.6 vs. 4.1 ± 0.8 ms2, p = 0.04; non-medical students: 6.0 ± 4.3 vs. 4.1 ± 2.6 ms2, p = 0.06).

Conclusions: The "pins" sound, which medical students remembered from their anatomy practical exam, provoked greater sympathetic activity in the medical student group than in their non-medical peers. Thus, past strong experiences modulate CV autonomic responses to acute acoustic stress.
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January 2020

Cranial Irradiation in Childhood Acute Lymphoblastic Leukemia Is Related to Subclinical Left Ventricular Dysfunction and Reduced Large Artery Compliance in Cancer Survivors.

J Clin Med 2019 Nov 13;8(11). Epub 2019 Nov 13.

Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, 10 Śniadeckich Street, 31-531 Cracow, Poland.

Long-term survivors of acute lymphoblastic leukemia (ALL), the most common childhood malignancy, are at remarkably increased risk of heart failure (HF) in middle age, most likely due anthracycline cardiotoxicity. The role of cranial radiation therapy (CRT) in the development of left ventricular (LV) dysfunction, a predecessor of overt HF, remains unclear. Our aim was to compare LV function and systemic arterial properties according to past CRT in young adult survivors of anthracycline-treated ALL. We studied young adult survivors of childhood ALL at a median of 16 years from diagnosis treated with anthracycline-based chemotherapy, with ( = 12) or without ( = 30) CRT. In addition to fractional shortening (FS) and ejection fraction (EF), LV function was quantified by tissue Doppler imaging of the mitral annulus. Aortic strain/distensibility and arterial compliance were derived from echocardiography and simultaneously recorded pulse pressure. Despite similar FS and EF, peak mitral annular systolic velocity (median (interquartile range): 9.0 (7.5-10.0) vs. 10.0 (8.8-11.5) cm/s, = 0.05), and early diastolic velocity (13.8 (13.0-14.8) vs. 15.5 (14.0-17.3), = 0.01) were decreased after chemotherapy combined with CRT compared to chemotherapy without CRT. Systemic arterial compliance was lower in post-CRT subjects (1.0 (0.8-1.2 vs. 1.4 (1.1-1.7) mL/mmHg, = 0.002). Aortic strain and distensibility were similar regardless of prior CRT. In conclusion, lower arterial compliance and subclinical LV dysfunction may be possible late consequences of past CRT in adult survivors of childhood ALL. Whether arterial stiffening is associated with future HF development in CRT-exposed ALL survivors remains to be investigated.
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http://dx.doi.org/10.3390/jcm8111952DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6912438PMC
November 2019

Better Myocardial Function in Aortic Stenosis with Low Left Ventricular Mass: A Mechanism of Protection against Heart Failure Regardless of Stenosis Severity?

J Clin Med 2019 Nov 1;8(11). Epub 2019 Nov 1.

Second Department of Cardiology, Jagiellonian University Medical College, 31-501 Cracow, Poland.

About one-tenth to one-third of patients with severe aortic stenosis (AS) do not develop left ventricular hypertrophy (LVH). Intriguingly, the absence of LVH despite severe AS is associated with lower prevalence of heart failure (HF), which challenges the classical notion of LVH as a beneficial compensatory response. Notably, the few studies that have attempted to characterize AS subjects with inadequately low left ventricular (LV) mass relative to LV afterload (i-lowLVM) described better prognosis and enhanced LV performance in AS associated with i-lowLVM, but those reports were limited to severe AS. Our aim was to compare myocardial function between moderate and severe AS with i-lowLVM. We retrospectively analyzed in-hospital records of 225 clinically stable nondiabetic patients with isolated moderate or severe degenerative AS in sinus rhythm, free of coexistent diseases. Subjects with i-lowLVM were compared to those with appropriate or excessive LVM (a/e-LVM), defined on the basis of the ratio of a measured LVM to the LVM predicted from an individual hemodynamic load. Patients with i-lowLVM and a/e-LVM did not differ in aortic valve area, LV end-diastolic diameter (LVd, a measure of LV preload), and circumferential end-systolic LV wall stress (cESS), an estimate of LV afterload. Compared to a/e-LVM, patients with i-lowLVM had increased LV ejection fraction (EF) and especially higher LV midwall fractional shortening (a better index of LV myocardial function than EF in concentric LV geometry) ( < 0.001-0.01), in both moderate and severe AS. LVd and cESS were similar in the four subgroups of the study subjects, i.e., moderate AS with i-lowLVM, moderate AS with a/e-LVM, severe AS with i-lowLVM, and severe AS with a/e-LVM ( > 0.6). Among patients with i-lowLVM, LVM did not differ significantly between moderate and severe AS ( > 0.4), while in those with a/e-LVM, LVM was increased in severe versus moderate AS ( < 0.001). In conclusion, the association of the low-LVM phenotype with better myocardial contractility may already develop in moderate AS. Additionally, cESS appears to be a controlled variable, which is kept constant over AS progression irrespective of LVM category, but even when controlled (by increasing LVM), is not able to prevent deterioration of LV function. Whether improved myocardial performance contributes to favorable prognosis and the preventive effect against HF in AS without LVH, remains to be studied.
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http://dx.doi.org/10.3390/jcm8111836DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6912368PMC
November 2019

Long-term clinical outcomes of direct absorb bioresorbable vascular scaffold implantation in acute coronary syndrome.

Minerva Cardioangiol 2019 Oct 13;67(5):374-379. Epub 2019 Sep 13.

Second Department of Cardiology and Cardiovascular Interventions, Jagiellonian University Medical College, Cracow, Poland -

Background: Preferred technique for bioresorbable vascular scaffold (BVS) implantation included high pressure predilation. Data about direct BVS implantation in acute coronary syndrome (ACS) patients are scarce.

Methods: Analysis of 90 consecutive patients with acute myocardial infarction (MI) treated with primary PCI with Absorb deployment between 2013-2016 in a single center. In 45 patients, scaffolds were implanted in the direct technique, other 45 patients underwent Absorb deployment after balloon predilation.

Results: Follow-up was available in 100% of patients with mean duration of 32±11 months. No cardiac death or scaffold thrombosis were observed in both groups. In the direct group, no target lesion revascularization (TLR) was reported. In the predilation arm, TLR occurred in 4 (9%) patients (P=0.12). Target vessel revascularization (TVR) was observed in 1 (2%) case in the direct group and in 6 (13%) patients from the predilation group (P=0.11). Target vessel MI was reported in one patient from each group. In an intention to treat analysis, we observed significantly higher rates of TVR (15% vs. 2%; P<0.043) and TLR (10% vs. 0%; P=0.038) in the predilation arm. Kaplan-Meier survival analysis did not show significant differences in TLR, TVR and device oriented composite endpoint (a combination of cardiac death, target vessel MI and ischemia driven TLR) between patients treated with both methods.

Conclusions: Direct Absorb implantation in patients with ACS may be feasible and safe.
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http://dx.doi.org/10.23736/S0026-4725.19.04854-0DOI Listing
October 2019

Depressed systemic arterial compliance and impaired left ventricular midwall performance in aortic stenosis with concomitant type 2 diabetes: a retrospective cross-sectional study.

Cardiovasc Diabetol 2019 07 17;18(1):92. Epub 2019 Jul 17.

Second Department of Cardiology, Jagiellonian University Medical College, 17 Kopernika Street, PL31-501, Cracow, Poland.

Background: Degenerative aortic stenosis (AS), a disease of the elderly, frequently coexists with concomitant diseases, including type 2 diabetes (T2DM) which amplifies the cardiovascular (CV) risk. T2DM affects left ventricular (LV) structure and function via hemodynamic and metabolic factors. In concentric LV geometry, typical for AS, indices of LV midwall mechanics are better estimates of LV function than ejection fraction (EF). Effects of T2DM coexisting with AS on circumferential LV midwall systolic function and large artery properties have not been reported so far. Our aim was to compare characteristics of AS patients with and without T2DM, with a focus on LV midwall systolic function and arterial compliance.

Methods: Medical records of 130 electively hospitalized patients with moderate or severe isolated degenerative AS were retrospectively analyzed. Exclusion criteria included clinical instability, atrial fibrillation, coronary artery disease and relevant non-cardiac diseases. From in-hospital echocardiography and blood pressure, we calculated LV midwall fractional shortening (mwFS), circumferential end-systolic LV wall stress (cESS) and valvulo-arterial impedance (Zva), estimates of LV afterload, as well as systemic arterial compliance.

Results: Patients with (n = 50) and without T2DM (n = 80) did not differ in age, AS severity, LV mass and LV diastolic diameter. T2DM patients exhibited elevated cESS (247 ± 105 vs. 209 ± 84 hPa, p = 0.025) and Zva (5.8 ± 2.2 vs. 5.1 ± 1.8 mmHg per mL/m, p = 0.04), and lower stroke volume index (33 ± 10 vs. 38 ± 12 mL/m, p = 0.01) and systemic arterial compliance (0.53 ± 0.16 vs. 0.62 ± 0.22 mL/m per mmHg, p = 0.01). mwFS (11.9 ± 3.9 vs. 14.1 ± 3.7%, p = 0.001), but not EF (51 ± 14 vs. 54 ± 13%, p = n.s.), was reduced in T2DM. mwFS and cESS were inversely interrelated in patients both with (r = - 0.59, p < 0.001) and without T2DM (r = - 0.53, p < 0.001) By multiple regression, higher cESS (p < 0.001) and T2DM (p = 0.02) were independent predictors of depressed mwFS.

Conclusions: In AS, coexistent T2DM appears associated with reduced systemic arterial compliance and LV dysfunction at the midwall level, corresponding to slightly depressed myocardial contractility.
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http://dx.doi.org/10.1186/s12933-019-0894-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6636034PMC
July 2019

Distinct associations between plasma osteoprotegerin, homoarginine and asymmetric dimethylarginine in chronic kidney disease male patients with coronary artery disease.

Amino Acids 2019 Jun 2;51(6):977-982. Epub 2019 May 2.

Institute of Toxicology, Core Unit Proteomics, Hannover Medical School, 30623, Hannover, Germany.

High plasma osteoprotegerin (OPG) and asymmetric dimethylarginine (ADMA) and low homoarginine (hArg) predict adverse renal and cardiovascular (CV) outcomes. In patients with chronic kidney disease and stable coronary artery disease, plasma OPG correlated with hArg (r = - 0.37, P = 0.03) and the hArg/ADMA molar ratio (r = - 0.46, P = 0.009), which was maintained upon adjustment for renal function. Elevated OPG levels and decreased hArg/ADMA ratios independently predicted 4-year composite CV and renal endpoints (CV death or progression to dialysis). Thus, high OPG and low hArg/ADMA ratio, albeit interrelated, appear to independently contribute to adverse clinical outcome.
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http://dx.doi.org/10.1007/s00726-019-02738-xDOI Listing
June 2019

Impact of Coronary Artery Disease and Diabetes Mellitus on the Long-Term Follow-Up in Patients after Retrograde Recanalization of the Femoropopliteal Arterial Region.

J Diabetes Res 2019 31;2019:6036359. Epub 2019 Mar 31.

2nd Department of Cardiology, Jagiellonian University Collegium Medicum, Krakow, Poland.

The most relevant comorbidities in patients with peripheral artery disease (PAD) are coronary artery disease (CAD) and diabetes mellitus (DM). However, data of long-term follow-up of patients with chronic total occlusion (CTO) are scarce. The aim of the study was to assess the impact of CAD and DM on long-term follow-up patients after superficial femoral artery (SFA) CTO retrograde recanalization. In this study, eighty-six patients with PAD with diagnosed CTO in the femoropopliteal region and at least one unsuccessful attempt of antegrade recanalization were enrolled in 2 clinical centers. Mean time of follow-up in all patients was 47.5 months (±40 months). Patients were divided into two groups depending on the presence of CAD (CAD group: = 45 vs. non-CAD group: = 41) and DM (DM group: = 50 vs. non-DM group: = 36). In long-term follow-up, major adverse peripheral events (MAPE) occurred in 66.6% of patients with CAD vs. 36.5% of patients without CAD and in 50% of patients with DM vs. 55% of non-DM subjects. There were no statistical differences in peripheral endpoints in both groups. However, there was a statistically significant difference in all-cause mortality: in the DM group, there were 6 deaths (12%) ( value = 0.038). To conclude, patients after retrograde recanalization, with coexisting CTO and DM, are at higher risk of death in long-term follow-up.
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http://dx.doi.org/10.1155/2019/6036359DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6462337PMC
November 2019

Platelet Reactivity And Circulating Platelet-Derived Microvesicles Are Differently Affected By P2Y Receptor Antagonists.

Int J Med Sci 2019 1;16(2):264-275. Epub 2019 Jan 1.

Second Department of Cardiology, Jagiellonian University Medical College, Cracow, Poland.

: Platelet-derived microvesicles (PMVs), shed from platelet surface membranes, constitute the majority of circulating microvesicles and have been implicated in procoagulant, pro-inflammatory and pro-atherosclerotic effects. Our aim was to compare plasma PMVs numbers in relation to platelet reactivity during dual antiplatelet therapy (DAPT) with various P2Y adenosine diphosphate (ADP) receptor antagonists. In pre-discharge men treated with DAPT for an acute coronary syndrome, plasma PMVs were quantified by flow cytometry on the basis of CD62P (P-selectin) and CD42 (glycoprotein Ib) positivity, putative indices of PMVs release from activated and all platelets, respectively. ADP-induced platelet aggregation was measured by multiple-electrode aggregometry. Clinical characteristics were similar in patients on clopidogrel (n=16), prasugrel (n=10) and ticagrelor (n=12). Platelet reactivity was comparably reduced on ticagrelor or prasugrel versus clopidogrel (p<0.01). Compared to clopidogrel-treated patients, CD42/CD62P PMVs counts were 3-4-fold lower in subjects receiving ticagrelor (p=0.001) or prasugrel (p<0.05), while CD42 PMVs were significantly reduced on ticagrelor (by about 6-fold, p<0.001), but not prasugrel (p=0.3). CD42/CD62P PMVs numbers correlated positively to the ADP-induced aggregation on clopidogrel (p<0.01) or prasugrel (p<0.05), which was absent in ticagrelor users (p=0.8). CD42 PMVs counts were unrelated to platelet reactivity (p>0.5). Higher antiplatelet potency of prasugrel and ticagrelor versus clopidogrel is associated with decreased plasma CD42/CD62P PMVs numbers. However, in contrast to thienopyridines, the association of reduced CD42/CD62P PMVs counts with ticagrelor use appears independent of its anti-aggregatory effect. Despite similar platelet-inhibitory activity of ticagrelor and prasugrel, only the treatment with ticagrelor seems associated with lower total PMVs release. Our preliminary findings may suggest a novel pleiotropic effect of ticagrelor extending beyond pure anti-aggregatory properties of the drug.
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http://dx.doi.org/10.7150/ijms.28580DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6367525PMC
June 2019

Impact of sex on the follow-up course and predictors of clinical outcomes in patients hospitalised due to myocardial infarction with non-obstructive coronary arteries: a single-centre experience.

Kardiol Pol 2019;77(2):198-206. Epub 2019 Jan 3.

2nd Department of Cardiology, Jagiellonian University Medical College.

Background: Myocardial infarction with non-obstructive coronary arteries (MINOCA) occurs more often in women.

Aim: We sought to assess the relationship between sex and clinical outcomes during follow-up in patients after MINOCA and to identify predictors of major adverse cardiac and cerebrovascular events (MACCE).

Methods: The study comprised 134 patients (78 women) at the mean age of 61.6 years, who were diagnosed with MINOCA at the Department of Cardiology between January 2015 and June 2018. The mean follow-up duration was 609.5 ± 412.2 days. Pri-mary study endpoints were MACCE, which included all-cause death, myocardial infarction, reintervention, and cerebral stroke. Secondary endpoints were recurrent chest pain during follow-up and rehospitalisation for reasons other than MACCE.

Results: Kaplan-Meier survival curve analysis did not reveal any significant differences in the frequency of MACCE (p = 0.63) or mortality rate (p = 0.29) between men and women. There was no significant impact of sex on secondary study endpoints either. Sex was not identified as a predictor of primary or secondary study endpoints in univariate or multivariate analysis. Troponin index (risk ratio [RR] 1.002; 95% confidence interval [CI] 1.0005-1.0026, p = 0.004), age (RR 1.04; 95% CI 1.008-1.065, p = 0.01), serum creatinine level (RR 1.01; 95% CI 1.001-1.01, p = 0.02), hyperlipidaemia (RR 0.26; 95% CI 0.07-0.75, p = 0.01), and prior venous thromboembolic disease (RR 8.28; 95% CI 1.15-38, p = 0.04) were found to be predictors of MACCE in multivariate analysis.

Conclusions: Sex was not found to be significantly associated with clinical outcomes during the follow-up period in patients with MINOCA.
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http://dx.doi.org/10.5603/KP.a2018.0245DOI Listing
August 2019

CHADS-VASc and R-CHADS-VASc scores predict in-hospital and post-discharge outcome in patients with myocardial infarction.

Postepy Kardiol Interwencyjnej 2018 11;14(4):391-398. Epub 2018 Dec 11.

Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland.

Introduction: The CHADS-VASc and R-CHADS-VASc scores were initially designed to evaluate the risk of cerebrovascular events in patients with atrial fibrillation. However, these scales consist of parameters which are well known as general risk factors for cardiovascular events.

Aim: To assess the role of the CHADS-VASc and R-CHADS-VASc scores in predicting outcome of patients with myocardial infarction (MI).

Material And Methods: We enrolled 212 consecutive patients with both ST-elevation and non-ST-elevation MI referred for primary percutaneous coronary intervention (PCI). Patients were divided into two groups depending on the CHADS-VASc score: ≤ 3 (low score) and > 3 points (high score).

Results: The group with a CHADS-VASc score > 3 points consisted of 93 (44%) patients. Follow-up was available in 200 (94.3%) patients with median duration of 10 (Q1: 6; Q3: 13) months. During the follow-up all-cause mortality was greater in patients from the high score group (21%) compared to patients with lower scores (8%) ( = 0.009). Recurrent MI was found in 4% of patients from the low score group and in 13% of patients from the high score group ( = 0.024). The combined endpoint of cardiovascular mortality, recurrent non-fatal MI and non-fatal stroke occurred in 13% of lower score patients and in 30% of patients with a score > 3 points ( = 0.002). In a Cox regression model both scores were predictors of all-cause mortality with a hazard ratio of 1.31 per 1 point increase for the CHADS-VASc score ( = 0.004) and 1.36 for the R-CHADS-VASc score ( < 0.001).

Conclusions: The CHADS-VASc and R-CHADS-VASc scores predict in-hospital and post-discharge outcome in patients with acute MI undergoing primary PCI.
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http://dx.doi.org/10.5114/aic.2018.79869DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6309841PMC
December 2018

Is left ventricular hypertrophy a friend or foe of patients with aortic stenosis?

Postepy Kardiol Interwencyjnej 2018 3;14(4):328-337. Epub 2018 Oct 3.

Second Department of Cardiology, Jagiellonian University Medical College, Krakow, Poland.

Left ventricular hypertrophy (LVH) is traditionally considered a physiological compensatory response to LV pressure overload, such as hypertension and aortic stenosis (AS), in an effort to maintain LV systolic function in the face of an increased afterload. According to the Laplace law, LV wall thickening lowers LV wall stress, which in turn would be helpful to preserve LV systolic performance. However, numerous studies have challenged the notion of LVH as a putative beneficial adaptive mechanism. In fact, the magnitude of LVH is associated with higher cardiovascular morbidity and mortality, especially when LVH is disproportionate to LV afterload. We have briefly reviewed: first, the importance of non-valvular factors, beyond AS severity, for total LV afterload and symptomatic status in AS patients; second, associations of excessive LVH with LV dysfunction and adverse outcome in AS; third, prognostic relevance of the presence or absence of pre-operative LVH in patients referred for aortic valve surgery; fourth, time course, determinants and prognostic implications of LVH regression and LV function recovery after surgical valve replacement and transcatheter aortic valve implantation (TAVI) with a focus on TAVI-specific effects; fifth, the potential of medical therapy to modulate LVH before and after surgical or interventional treatment for severe AS, a condition perceived as a relative contraindication to renin-angiotensin system blockade.
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http://dx.doi.org/10.5114/aic.2018.78734DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6309834PMC
October 2018

Hospitalization Length after Myocardial Infarction: Risk-Assessment-Based Time of Hospital Discharge vs. Real Life Practice.

J Clin Med 2018 Dec 18;7(12). Epub 2018 Dec 18.

Institute of Cardiology, Jagiellonian University Medical College, 31-501 Krakow, Poland.

According to guidelines, it is safe for low-risk patients with myocardial infarction (MI) to be discharged within 72 h of hospitalization. However, results coming from registries show that the hospital stay is often much longer in a real-life situation. Data on the length of the hospital stay (LOS) of MI patients in Polish centers are lacking. We enrolled 212 consecutive patients with acute MI. Low-risk patients were defined according to PAMI II criteria: age <70 years, left ventricular ejection fraction (LVEF) >45%, no persistent ventricular arrhythmia, and no multi-vessel disease (MVD). The median of the hospitalization length was eight days (Q1: 6; Q3: 9). In low-risk patients (25%), the median of LOS was six days (Q1: 5; Q3: 7) ( < 0.001). In a logistic regression analysis patients age, LVEF, ST-segment-elevation MI and the presence of MVD were independent predictors of longer hospitals stay (≥8 days). During follow up, there were no significant differences in the rates of clinical events between patients with shorter (<8 days) and longer (≥8 days) hospitalization. In a real-life situation, the LOS, even in low-risk patients is much longer than recommended in the guidelines.
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http://dx.doi.org/10.3390/jcm7120564DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6306951PMC
December 2018

Association of Inadequately Low Left Ventricular Mass with Enhanced Myocardial Contractility in Severe Degenerative Aortic Stenosis.

J Clin Med 2018 Nov 22;7(12). Epub 2018 Nov 22.

Second Department of Cardiology, Jagiellonian University Medical College, 17 Kopernika Street, 31-501 Cracow, Poland.

Background: Left ventricular hypertrophy (LVH), traditionally considered an adaptive mechanism that is aimed at the maintenance of LV systolic function, is absent in 10%⁻35% of patients with severe aortic stenosis (AS). Our aim was to estimate the clinical and hemodynamic characteristics in patients with severe AS and absent LVH, or inadequately low LV mass (i-lowLVM) relative to an individual hemodynamic load.

Methods: We retrospectively analyzed in-hospital records of 100 patients with pure severe degenerative AS, preserved LV systolic function and without relevant coexistent diseases, except for well-controlled hypertension or diabetes.

Results: Clinical characteristics were similar in patients with and without LVH, as well as those with and without i-lowLVM, except for slightly lower GFR at i-lowLVM. When compared to their counterparts, subjects without LVH or with i-lowLVM had smaller LV cavities, decreased LV wall thicknesses and higher EF. There were no significant differences in stenosis severity and indices of afterload (valvulo-arterial impedance and circumferential end-systolic LV wall stress), according to the presence or absence of either LVH or i-lowLVM. However, LV fractional shortening at the midwall level was elevated only in patients with i-lowLVM, but not in those without LVH, compared to the remainder (15.8 ± 3.3 vs. 12.9 ± 3.2%, < 0.001 for those with and without i-lowLVM, respectively; 13.7 ± 3.7 vs. 13.8 ± 3.6% for LVH presence and absence, = 0.9).

Conclusions: Inadequately low LVM relative to the individual hemodynamic load could potentially reflect a different mode of the LV response to severe AS, associated with enhanced load-independent LV systolic performance, i.e., better LV contractility. If confirmed in a large series of patients, our small preliminary study may add to the possible mechanisms of a previously reported counterintuitive tendency of a lower, not higher, risk of adverse outcome in patients with low LV mass despite severe AS. Prospective studies are warranted, in order to determine a potential utility of LVM inadequacy in the risk stratification of patients with AS.
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http://dx.doi.org/10.3390/jcm7120464DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6306843PMC
November 2018

Association between low-grade chronic inflammation and depressed left atrial compliance in heart failure with preserved ejection fraction: A retrospective analysis.

Folia Med Cracov 2018;58(2):45-55

Second Department of Cardiology, Jagiellonian University Medical College, Kopernika 17, Kraków, Poland.

Background: A novel paradigm of diastolic heart failure with preserved ejection fraction (HFpEF) proposed the induction of coronary microvascular dysfunction by HFpEF comorbidities via a systemic pro-inflammatory state and associated oxidative stress. The consequent nitric oxide deficiency would increase diastolic tension and favor fibrosis of adjacent myocardium, which implies not only left ventricular (LV), but all-chamber myocardial stiffening. Our aim was to assess relations between low-grade chronic systemic inflammation and left atrial (LA) pressure-volume relations in real-world HFpEF patients.

Methods: We retrospectively analyzed medical records of 60 clinically stable HpEFF patients in sinus rhythm with assayed high-sensitive C-reactive protein (CRP) during the index hospitalization. Subjects with CRP >10 mg/L or coexistent diseases, including coronary artery disease, were excluded. LV and LA diameters and mitral E/E' ratio (an index of LA pressure) were extracted from routine echocardiographic records. A surrogate measure of LA stiffness was computed as the averaged mitral E/e' ratio divided by LA diameter.

Results: With ascending CRP tertiles, we observed trends for elevated mitral E/e' ratio (p <0.001), increased relative LV wall thickness (p = 0.01) and higher NYHA functional class (p = 0.02). The LA stiffness estimate and log-transformed CRP levels (log-CRP) were interrelated (r = 0.38, p = 0.003). On multi- variate analysis, the LA stiffness index was independently associated with log-CRP (β ± SEM: 0.21 ± 0.07, p = 0.007) and age (β ± SEM: 0.16 ± 0.07, p = 0.03), which was maintained upon adjustment for LV mass index and relative LV wall thickness.

Conclusions: Low-grade chronic inflammation may contribute to LA stiffening additively to age and regardless of the magnitude of associated LV hypertrophy and concentricity. LA stiffening can exacerbate symptoms of congestion in HFpEF jointly with LV remodeling.
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http://dx.doi.org/10.24425/fmc.2018.124657DOI Listing
September 2019